Chronic Kidney Disease Clinical Trial
— CONTINUITYOfficial title:
An Open-Label, Randomised, Phase 4 Study of Continuing Sodium Zirconium Cyclosilicate (SZC) After Discharge in Participants With Chronic Kidney Disease Treated for Hyperkalaemia
This is an open-label, randomised study in participants with chronic kidney disease (CKD) treated for hyperkalaemia (HK) whilst in hospital. The study will compare SZC to standard of care (SoC) with the goal of determining: - If continued use of SZC maintains normokalaemia (NK) better than SoC after participant discharge from the hospital. - If continued use of SZC after discharge will reduce HK related healthcare resource utilisation compared to SoC.
Status | Recruiting |
Enrollment | 130 |
Est. completion date | December 25, 2024 |
Est. primary completion date | December 25, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 130 Years |
Eligibility | Inclusion Criteria: - Must be 18 years of age or older, at the time of signing the informed consent - Admitted to hospital (inpatient care; directly or from ED) - With: 1. Diagnosed CKD (any stage) or 2. eGFR < 90 ml/min/1.73 m2 at, or within 3 months of, study screening, based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (Levey et al, 2009). Note: Race/ethnicity should not be included in CKD-EPI equation calculation. - Local laboratory K+ measurement within 24 hours of baseline visit (visit 2), where result is either: - Hyperkalaemic as defined by site's local practice and K+ = 6.5 mmol/L. - Or, normokalaemic: K+ between = 3.5 and = 5.0 mmol/L, where patient started and is receiving treatment for this episode of HK - Male or female - Capable and willing of giving signed informed consent as described in Appendix A which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. Exclusion Criteria: - Hospitalisation for an acute cardiovascular event within 12 weeks prior to screening - Unable to take oral SZC drug mix - With a life expectancy of less than 6 months - Any medical condition that, in the opinion of the investigator makes the participant not suitable for inclusion - QT interval corrected by the Fridericia method (QTcF) > 550 msec - History of QT prolongation associated with other medications that required discontinuation of that medication - Congenital long QT syndrome - Clinically significant arrythmias as judged by the investigator - Ongoing treatment with SZC or patiromer before current ED visit/hospital admission (ongoing treatment with other K-binders before current ED visit/hospital admission is allowed). Note: Initiation of any SZC or patiromer during the current ED visit/hospitalisation preceding enrolment is allowed. - Chronic haemodialysis or peritoneal dialysis or the recipient of or scheduled date for a kidney transplant. Note: Emergency/unscheduled haemodialysis to treat HK during the current ED visit/hospitalisation preceding enrolment is allowed. - Participation in another clinical study with an investigational medicinal product (IMP) administered during the month before screening. - Known hypersensitivity to SZC or any of the excipients of the product - Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site) - Judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions, and requirements - Previous randomisation in the present study - For women only: Women of child-bearing potential (WOCBP; ie, those who are not chemically or surgically sterilised or who are not post-menopausal) who are not willing to use one of the methods of contraception described hereafter, or who are not stable on the contraception method for the last one month, from the time of signing the informed consent throughout the study and 7 days after the last dose: (a) Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: oral, intravaginal, transdermal (b) Progestogen-only hormonal contraception associated with inhibition of ovulation: oral, injectable, implantable (c) Intrauterine device (d) Intrauterine hormone-releasing system (e) Bilateral tubal occlusion (f) Vasectomised partner (vasectomised partner is a highly effective birth control method provided that partner is the sole sexual partner of the WOCBP participant and that the vasectomised partner has received medical assessment of the surgical success (g) Sexual abstinence: it is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the study and the preferred and usual lifestyle of the participant. - For WOCBP only: Women who have a positive pregnancy test at screening OR women who are breastfeeding. |
Country | Name | City | State |
---|---|---|---|
Belgium | Research Site | Belgium | |
Belgium | Research Site | Bonheiden | |
Belgium | Research Site | Dendermonde | |
Belgium | Research Site | Leuven | |
Belgium | Research Site | Lodelinsart | |
France | Research Site | Annonay | |
France | Research Site | Ars-Laquenexy | |
France | Research Site | La Tronche | |
France | Research Site | Nice | |
France | Research Site | Saint-priest En Jarez | |
Germany | Research Site | Kaiserslautern | |
Italy | Research Site | Acireale | |
Italy | Research Site | Bari | |
Italy | Research Site | Foggia | |
Italy | Research Site | Parma | |
Italy | Research Site | Pavia | |
Italy | Research Site | Pavia | |
Italy | Research Site | Roma | |
Netherlands | Research Site | Amsterdam | |
Netherlands | Research Site | Eindhoven | |
Netherlands | Research Site | Groningen | |
Netherlands | Research Site | Rotterdam | |
Spain | Research Site | Alcalá De Henares | |
Spain | Research Site | Algeciras | |
Spain | Research Site | Alicante | |
Spain | Research Site | Almería | |
Spain | Research Site | Badajoz | |
Spain | Research Site | Barcelona | |
Spain | Research Site | Burgos | |
Spain | Research Site | Getafe | |
Spain | Research Site | Madrid | |
Spain | Research Site | Madrid | |
Spain | Research Site | Madrid | |
Spain | Research Site | Palma de Mallorca | |
Spain | Research Site | Salamanca | |
Spain | Research Site | San Sebastián de los Reyes | |
Spain | Research Site | Santiago de Compostela | |
Spain | Research Site | Sevilla | |
Spain | Research Site | Talavera de la Reina | |
Spain | Research Site | Zamora | |
United Kingdom | Research Site | Cardiff | |
United Kingdom | Research Site | Doncaster | |
United Kingdom | Research Site | Edinburgh | |
United Kingdom | Research Site | Hull | |
United Kingdom | Research Site | Leicester | |
United Kingdom | Research Site | London | |
United Kingdom | Research Site | Salford | |
United Kingdom | Research Site | Stevenage | |
United Kingdom | Research Site | York |
Lead Sponsor | Collaborator |
---|---|
AstraZeneca |
Belgium, France, Germany, Italy, Netherlands, Spain, United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Adverse Events (AE) | Assessments related to AEs cover: Occurrence/frequency, Relationship to SZC as assessed by investigator, Intensity, Seriousness, Death, AEs leading to discontinuation of SZC. | From time of signature of the ICF, throughout the treatment period and including the follow-up period, 201 days maximum | |
Other | Weight in kilograms | Weight will be measured using the same scale and in the same state of dress as part of vital signs | From time of signature of the ICF, throughout the treatment period and including the follow-up period, 201 days maximum | |
Other | Height in centimeters | Height will be measured as part of vital signs. | Height will be measured at screening visit | |
Other | Blood pressure (BP) in mmHg | Blood pressure should be measured with a completely automated device in triplicate with at least 1-minute intervals between measurements after being comfortably at rest in a seated position with the back and feet supported quietly for at least 5 minutes. Manual techniques will be used only if an automated device is not available. The same device should preferably be used for the participant during the course of the study and in the same arm. | From time of signature of the ICF, throughout the treatment period and including the follow-up period, 201 days maximum | |
Other | Pulse rate in beats/min | Pulse rate should be measured with a completely automated device in triplicate with at least 1-minute intervals between measurements after being comfortably at rest in a seated position with the back and feet supported quietly for at least 5 minutes. Manual techniques will be used only if an automated device is not available. The same device should preferably be used for the participant during the course of the study and in the same arm. | From time of signature of the ICF, throughout the treatment period and including the follow-up period, 201 days maximum | |
Other | Clinical safety laboratory tests | Serum electrolytes values(mmol/L), serum BUN(mmol/L), urinalysis and others | From time of signature of the ICF, throughout the treatment period and the follow-up period, 201 days maximum | |
Other | Electrocardiograms (ECG) | An ECG will be performed throughout study participation and according to clinical judgment in connection with severe hypokalaemia (K+ < 3.0 mmol/L), severe HK (K+ > 6.0 mmol/L), or any symptoms or clinical events suggesting cardiac arrhythmia. | From time of signature of the ICF, throughout the treatment period and the follow-up period, 201 days maximum | |
Other | Time to first occurrence of any component of hospital admission or ED visit, both with HK as a contributing factor, or all-cause death | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of the composite outcome of hospital admissions or ED visits with HK as a contributing factor or all-cause death | Up to 180 days post-discharge | |
Other | Time to first occurrence of either hospital admission with HK as a contributing factor or allcause death | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of hospital admissions with HK as a contributing factor or all-cause death | Up to 180 days post-discharge | |
Other | Time to first occurrence of either ED visit with HK as a contributing factor or all-cause death | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of ED visits with HK as a contributing factor or all-cause death | Up to 180 days post-discharge | |
Other | Time to first occurrence of any component of all-cause hospitalisations, ED visits, use of rescue therapy for HK or all-cause death in each arm | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of the composite outcome of all-cause hospitalisations, ED visits, all cause death, or use of rescue therapy for HK | Up to 180 days post-discharge | |
Other | K+ level | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, on mean K+ levels | Up to 180 days post-discharge | |
Other | Number of hospital admissions with HK as a contributing factor | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the number of hospital admissions with HK as a contributing factor | Up to 180 days post-discharge | |
Other | Time to first occurrence of K-binder use in each arm | To evaluate the effect of continuing SZC as part of discharge medications, compared to SoC in reducing the incidence of K-binder use | Up to 180 days post-discharge | |
Other | Frequency of the use of K-binder to treat HK in each arm | To evaluate the effect of continuing SZC as part of discharge medications, compared to SoC in reducing the frequency and duration of K-binder use | Up to 180 days post-discharge | |
Other | Time to first occurrence of rescue therapy use in each arm | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of rescue therapy for HK use | up to 180 days post-discharge | |
Other | Time to first occurrence of all-cause hospitalisations, ED visits, or outpatient visits in each arm | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of the composite outcome of all-cause hospitalisations, ED visits, or outpatient visits | up to 180 days post-discharge | |
Other | Rate of change in (slope) eGFR (estimated glomerular filtration rate) from inpatient phase | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in the change in eGFR | 90 and 180 days post-discharge | |
Other | Time to first occurrence of dialysis initiation in each arm | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in the incidence of dialysis initiation | up to 180 days post-discharge | |
Other | Time to first occurrence of ICU (intensive care unit) admissions in each arm | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of ICU admissions | up to 180 days post-discharge | |
Other | Frequency (%) of participants on RAASi (renin-angiotensin-aldosterone system inhibitor) at discharge who remained on / increased / decreased / initiated RAASi | This exploratory endpoint will descriptively summarise the use of RAASi in each treatment arm | 90 and 180 days post-discharge | |
Primary | Occurrence (yes/no) of normokalaemia (NK) (potassium [K+] between 3.5 and 5.0 mmol/L, inclusive) | To evaluate the efficacy of continuing SZC as part of the discharge medications, compared to SoC, in maintaining NK | Up to 180 days post-discharge | |
Secondary | Time to first occurrence of all-cause hospital admissions or ED visits with HK as a contributing factor, all-cause death, or use of rescue therapy for HK | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of the composite outcome of all-cause hospital admissions or ED visits with HK as a contributing factor, or all-cause death, or use of rescue therapy for HK | Up to 180 days post-discharge | |
Secondary | Time to first occurrence of all-cause hospital admission or ED visit, with HK as a contributing factor | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of hospital admissions or ED visit with HK as a contributing factor | Up to 180 days post-discharge | |
Secondary | Number of all-cause hospital admission or ED visits, with HK as a contributing factor | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the number of all-cause hospital admissions or ED visits with HK as a contributing factor | Up to 180 days post-discharge | |
Secondary | Time to first occurrence of hospital admission or ED visit with HK as a contributing factor between the SZC and SoC arms. | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the incidence of hospital admissions or ED visits with HK as a contributing factor. | Up to 180 days post-discharge | |
Secondary | Incidence rate of hospital admission or ED visit with HK as a contributing factor between the SZC and SoC arms. | To evaluate the effect of continuing SZC as part of the discharge medications, compared to SoC, in reducing the number of hospital admissions or ED visits with HK as a contributing factor. | Up to 180 days post-discharge | |
Secondary | Time to first occurrence of RAASi down-titration (or discontinuation) | To evaluate the effect of continuing SZC as part of the discharge medications compared to SoC on reducing the risk of RAASi down-titration (or discontinuation) | Up to 180 days post-discharge |
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